COVID-19 Vaccine Information for Pharmacy Billing


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TO:  All Pharmacy Providers


RE:   COVID-19 Vaccine Information for Pharmacy Billing

Alabama Medicaid will allow reimbursement to pharmacies for a vaccine administration fee to Medicaid providers who utilize federally-allocated COVID-19 vaccines. For claims effective March 15, 2021 and after, the reimbursement rate for the administration fee is $40.00 per dose, and will continue only during that time as described by the American Rescue Plan Act of 2021 that provides for increased FMAP for administration of the COVID-19 vaccine unless ended sooner by the Agency in a subsequent ALERT.


·   Pharmacies will bill vaccines through an electronic NCPDP claim.

o  Submit $0.00 or $0.01 for vaccine provided at no cost from the federal government. 

o  Submit each vaccine with the specific approved vaccine NDC for an eligible recipient.

o   Submit the administration fee in the Incentive Amount Submitted field (NCPDP Field 438-E3) on the same claim as the vaccine (i.e. ingredient).

o  Medicaid will allow for vaccine/administration with an effective date on/after December 28, 2020.

o   For claims on/after March 15, 2021, the administration fee is $40.00 per dose. 

o  Vaccines must be administered according to approved labeling for appropriate ages and dosing interval.


· Per the Public Readiness and Emergency Preparedness (PREP) Act, either    the Pharmacy or the Pharmacist NPI may be submitted on claims for COVID-19 vaccines only. 

o  Claims for administration of COVID-19 vaccines with the Pharmacy or Pharmacist NPI submitted in the prescriber field should be submitted with a SCC of 42 indicating that the prescriber ID submitted is valid and prescribing requirements have been validated. 


NCPDP Codes and Allowed Amounts for COVID-19 Vaccine Administration

Submission Clarification Code (440-E5)

Incentive Amount (Administration Fee 438-E3)

Ingredient Cost


Two Dose Vaccines

First Dose



$0.00 or $0.01

Second Dose



$0.00 or $0.01

Single-Dose Vaccines

Single Dose



$0.00 or $0.01


 ·  The payment rate for COVID-19 vaccine administration is $40.00 to administer any dose of the vaccine. As of March 15, 2021, the Submission Clarification Code indicating which dose is being administered is no longer required.

· To participate in the administration of COVID-19 vaccine, Alabama providers must enroll in the Alabama Department of Public Health’s (ADPH) ImmPRINT COVID-19 Vaccination Program. Follow the steps in the ImmPRINT Registration Roadmap to enroll.

· Pharmacies must follow state and federal laws and regulations regarding administration of vaccines.

· State and federal standing order guidelines for products granted Emergency Use Authorization (EUA) must be followed.  Standing order guidelines can be found at the links below.

o  Moderna:

Moderna COVID-19 Vaccine: Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (

o  Pfizer/BioNTech:

Pfizer-BioNTech COVID-19 Vaccine Standing Orders for Administering Vaccine (

o  Janssen (Currently the FDA and CDC have paused the use of the Janssen vaccine.  More information can be found here: Should this pause be lifted, the Janssen standing order can be found here):

Janssen COVID-19 Vaccine (Johnson & Johnson): Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (


Pharmacy providers with questions regarding vaccine administration may call the Alabama Medicaid Pharmacy Program at (334) 242-5050.

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